Karen Guitman

The Process


An individual psychotherapy session is 55 minutes long and relationship psychotherapy sessions are 75 minutes long. Sessions are usually scheduled either weekly or bi-weekly, depending on your availability, any financial concerns, and your sense of urgency. 


At the beginning of your therapeutic journey we will discuss your goals for therapy, your concerns, and possible approaches to working towards your goals. Throughout your therapeutic journey we will revisit these goals, sometimes directly exploring how far you feel you have come in meeting them, sometimes more indirectly by contemplating your journey in therapy so far.

During therapy, issues may come up that you didn’t even know you had. The new issue can sometimes feel worse than the original concern and may feel like a distraction. In most cases the newly discovered issue is the actual root of problems and needs to be explored and worked with. At those times your goals may have to be adjusted and we will do so together if and when it feels right.

Practical Process and Progress

Before your first session I will ask you to provide me with a history of your life to help get a first picture of your life experiences. This life history often also serves as a catalyst for clients, bringing awareness to parts of you that may hold confusion or painful emotions surrounding some past experiences or memories that had been repressed for many years.

During a psychotherapy session you will be given space to explore your parts. Sessions often start with a recounting of those events that stood out for you throughout the week and usually progress from there to the topic you want to explore in that specific session and the parts that are related to that. Sometimes the topic coming up in one week may seem to have nothing to do with your reasons for coming to therapy originally; yet, in my experience almost all the situations that trigger us into uncomfortable feelings are connected and in some way relate back to our core issues. In other ways, all, or at least most, roads lead to the top of the same mountain. However, should you ever feel that we are really going ‘off topic’ for too long, let me know and we can adjust our direction.

Usually a session starts with ‘talk therapy’: exploring in words, stories, thoughts, concepts. We will then work together to begin to better understand your inner system and re-establish the trusting inner relationships that will lead to healing. I will work closely with you and your system and only do what feels safe, after all, we trust your system and will follow its lead.

Emotional Process and Progress

At its very core psychotherapy is about change. It is about learning to be your own best friend, to accept yourself and your parts unconditionally, and then to gently change what is not optimal. And like with all change, there are ups and downs in therapy.

Occasionally you may leave a session feeling worse than when you arrived. Whenever possible we will try to resolve such feelings before the session ends but some insights are big and shocking at first. If you can allow yourself to stay in the process, you will get through these difficult times. In fact, often it is facing these difficult moments in the therapeutic process that allows us to understand and truly experience the strength we have and a way to be truthful and compassionate with ourselves. Whatever the insight or shift, change may mean leaving behind something that is familiar and known for something that is new and uncertain. Whenever this happens, no matter how much parts of us may want the change and anticipate the new being better and brighter, we will have to allow some time and space for the parts that may need time to adjust to these new ways of being in the world.

Most clients experience therapy as a series of shifts and insights with time to adjust needed in between. Some insights may be painful; some shifts may be big: those will need more time, more revisiting, more testing in ‘real life’ to fully integrate. Other insights are big yet instantaneous and lead to a major shift right away, leaving clients elated and feeling wonderful about themselves. And yet other insights are seemingly small and lead to subtle shifts; sometimes the shifts are so subtle that clients don’t actually notice them until they realize at some point that they are more content and peaceful inside and have more balance in their lives outside.

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